Provider Demographics
NPI:1093420374
Name:ATEKWANE, KINNER ECHECHE
Entity Type:Individual
Prefix:
First Name:KINNER
Middle Name:ECHECHE
Last Name:ATEKWANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 S WALLRADE LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1494
Mailing Address - Country:US
Mailing Address - Phone:240-593-5359
Mailing Address - Fax:
Practice Address - Street 1:965 S WALLRADE LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1494
Practice Address - Country:US
Practice Address - Phone:240-593-5359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ257504364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health